|
MARCAINE(BUPIVACAIN)0.25% 30ML
|
Facility
|
IP
|
$114.52
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$109.94 |
| Rate for Payer: Aetna Commercial |
$88.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.33
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cigna Commercial |
$95.05
|
| Rate for Payer: First Health Commercial |
$108.79
|
| Rate for Payer: Humana Commercial |
$97.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.78
|
| Rate for Payer: Ohio Health Group HMO |
$85.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.02
|
| Rate for Payer: PHCS Commercial |
$109.94
|
| Rate for Payer: United Healthcare All Payer |
$100.78
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
IP
|
$0.25
|
|
| Hospital Charge Code |
636T0091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna Commercial |
$0.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna Commercial |
$0.21
|
| Rate for Payer: First Health Commercial |
$0.24
|
| Rate for Payer: Humana Commercial |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.22
|
| Rate for Payer: Ohio Health Group HMO |
$0.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.17
|
| Rate for Payer: PHCS Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Payer |
$0.22
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: Anthem Medicaid |
$26.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.86
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cigna Commercial |
$64.76
|
| Rate for Payer: First Health Commercial |
$74.13
|
| Rate for Payer: Humana Commercial |
$66.33
|
| Rate for Payer: Humana KY Medicaid |
$26.83
|
| Rate for Payer: Kentucky WC Medicaid |
$27.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.67
|
| Rate for Payer: Ohio Health Group HMO |
$58.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.84
|
| Rate for Payer: PHCS Commercial |
$74.91
|
| Rate for Payer: United Healthcare All Payer |
$68.67
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Professional
|
Both
|
$0.25
|
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Multiplan PHCS |
$0.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.18
|
| Rate for Payer: UHCCP Medicaid |
$0.09
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
OP
|
$0.25
|
|
| Hospital Charge Code |
636T0091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna Commercial |
$0.19
|
| Rate for Payer: Anthem Medicaid |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna Commercial |
$0.21
|
| Rate for Payer: First Health Commercial |
$0.24
|
| Rate for Payer: Humana Commercial |
$0.21
|
| Rate for Payer: Humana KY Medicaid |
$0.09
|
| Rate for Payer: Kentucky WC Medicaid |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.22
|
| Rate for Payer: Ohio Health Group HMO |
$0.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.17
|
| Rate for Payer: PHCS Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Payer |
$0.22
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
OP
|
$0.25
|
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna Commercial |
$0.19
|
| Rate for Payer: Anthem Medicaid |
$0.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna Commercial |
$0.21
|
| Rate for Payer: First Health Commercial |
$0.24
|
| Rate for Payer: Humana Commercial |
$0.21
|
| Rate for Payer: Humana KY Medicaid |
$0.09
|
| Rate for Payer: Kentucky WC Medicaid |
$0.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.22
|
| Rate for Payer: Ohio Health Group HMO |
$0.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.17
|
| Rate for Payer: PHCS Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Payer |
$0.22
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003204
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.86
|
| Rate for Payer: Cash Price |
$39.02
|
| Rate for Payer: Cigna Commercial |
$64.76
|
| Rate for Payer: First Health Commercial |
$74.13
|
| Rate for Payer: Humana Commercial |
$66.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.67
|
| Rate for Payer: Ohio Health Group HMO |
$58.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.84
|
| Rate for Payer: PHCS Commercial |
$74.91
|
| Rate for Payer: United Healthcare All Payer |
$68.67
|
|
|
MARCAINE(BUPIVACAINE)0.5% 30ML
|
Facility
|
IP
|
$0.25
|
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Aetna Commercial |
$0.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.20
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: Cigna Commercial |
$0.21
|
| Rate for Payer: First Health Commercial |
$0.24
|
| Rate for Payer: Humana Commercial |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.22
|
| Rate for Payer: Ohio Health Group HMO |
$0.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.17
|
| Rate for Payer: PHCS Commercial |
$0.24
|
| Rate for Payer: United Healthcare All Payer |
$0.22
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
OP
|
$0.18
|
|
| Hospital Charge Code |
636T0092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Anthem Medicaid |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna Commercial |
$0.15
|
| Rate for Payer: First Health Commercial |
$0.17
|
| Rate for Payer: Humana Commercial |
$0.15
|
| Rate for Payer: Humana KY Medicaid |
$0.06
|
| Rate for Payer: Kentucky WC Medicaid |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.16
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.12
|
| Rate for Payer: PHCS Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Payer |
$0.16
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
IP
|
$0.18
|
|
| Hospital Charge Code |
636T0092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna Commercial |
$0.15
|
| Rate for Payer: First Health Commercial |
$0.17
|
| Rate for Payer: Humana Commercial |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.16
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.12
|
| Rate for Payer: PHCS Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Payer |
$0.16
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
IP
|
$79.65
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$76.46 |
| Rate for Payer: Aetna Commercial |
$61.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.13
|
| Rate for Payer: Cash Price |
$39.83
|
| Rate for Payer: Cigna Commercial |
$66.11
|
| Rate for Payer: First Health Commercial |
$75.67
|
| Rate for Payer: Humana Commercial |
$67.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.09
|
| Rate for Payer: Ohio Health Group HMO |
$59.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.96
|
| Rate for Payer: PHCS Commercial |
$76.46
|
| Rate for Payer: United Healthcare All Payer |
$70.09
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
OP
|
$79.65
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$76.46 |
| Rate for Payer: Aetna Commercial |
$61.33
|
| Rate for Payer: Anthem Medicaid |
$27.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.13
|
| Rate for Payer: Cash Price |
$39.83
|
| Rate for Payer: Cigna Commercial |
$66.11
|
| Rate for Payer: First Health Commercial |
$75.67
|
| Rate for Payer: Humana Commercial |
$67.70
|
| Rate for Payer: Humana KY Medicaid |
$27.39
|
| Rate for Payer: Kentucky WC Medicaid |
$27.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.09
|
| Rate for Payer: Ohio Health Group HMO |
$59.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.96
|
| Rate for Payer: PHCS Commercial |
$76.46
|
| Rate for Payer: United Healthcare All Payer |
$70.09
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Professional
|
Both
|
$0.18
|
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Multiplan PHCS |
$0.11
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.13
|
| Rate for Payer: UHCCP Medicaid |
$0.06
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
IP
|
$0.18
|
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna Commercial |
$0.15
|
| Rate for Payer: First Health Commercial |
$0.17
|
| Rate for Payer: Humana Commercial |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.16
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.12
|
| Rate for Payer: PHCS Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Payer |
$0.16
|
|
|
MARCAINE(BUPIVACAINE)0.75 30ML
|
Facility
|
OP
|
$0.18
|
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Anthem Medicaid |
$0.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.14
|
| Rate for Payer: Cash Price |
$0.09
|
| Rate for Payer: Cigna Commercial |
$0.15
|
| Rate for Payer: First Health Commercial |
$0.17
|
| Rate for Payer: Humana Commercial |
$0.15
|
| Rate for Payer: Humana KY Medicaid |
$0.06
|
| Rate for Payer: Kentucky WC Medicaid |
$0.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.16
|
| Rate for Payer: Ohio Health Group HMO |
$0.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.12
|
| Rate for Payer: PHCS Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Payer |
$0.16
|
|
|
MARCAINE/EPIEPHRINE 0.25% 10ML
|
Facility
|
OP
|
$80.46
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003206
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$77.24 |
| Rate for Payer: Aetna Commercial |
$61.95
|
| Rate for Payer: Anthem Medicaid |
$27.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.76
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cigna Commercial |
$66.78
|
| Rate for Payer: First Health Commercial |
$76.44
|
| Rate for Payer: Humana Commercial |
$68.39
|
| Rate for Payer: Humana KY Medicaid |
$27.67
|
| Rate for Payer: Kentucky WC Medicaid |
$27.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.80
|
| Rate for Payer: Ohio Health Group HMO |
$60.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.52
|
| Rate for Payer: PHCS Commercial |
$77.24
|
| Rate for Payer: United Healthcare All Payer |
$70.80
|
|
|
MARCAINE/EPIEPHRINE 0.25% 10ML
|
Facility
|
IP
|
$80.46
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003206
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$77.24 |
| Rate for Payer: Aetna Commercial |
$61.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.76
|
| Rate for Payer: Cash Price |
$40.23
|
| Rate for Payer: Cigna Commercial |
$66.78
|
| Rate for Payer: First Health Commercial |
$76.44
|
| Rate for Payer: Humana Commercial |
$68.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.80
|
| Rate for Payer: Ohio Health Group HMO |
$60.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.52
|
| Rate for Payer: PHCS Commercial |
$77.24
|
| Rate for Payer: United Healthcare All Payer |
$70.80
|
|
|
MARCAIN+EPI 0.25%/1:200K50mLMD
|
Facility
|
IP
|
$119.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004309
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.00
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cigna Commercial |
$98.96
|
| Rate for Payer: First Health Commercial |
$113.27
|
| Rate for Payer: Humana Commercial |
$101.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.92
|
| Rate for Payer: Ohio Health Group HMO |
$89.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.27
|
| Rate for Payer: PHCS Commercial |
$114.46
|
| Rate for Payer: United Healthcare All Payer |
$104.92
|
|
|
MARCAIN+EPI 0.25%/1:200K50mLMD
|
Facility
|
OP
|
$119.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25004309
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$114.46 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Anthem Medicaid |
$41.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.00
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Cigna Commercial |
$98.96
|
| Rate for Payer: First Health Commercial |
$113.27
|
| Rate for Payer: Humana Commercial |
$101.35
|
| Rate for Payer: Humana KY Medicaid |
$41.00
|
| Rate for Payer: Kentucky WC Medicaid |
$41.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.92
|
| Rate for Payer: Ohio Health Group HMO |
$89.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.27
|
| Rate for Payer: PHCS Commercial |
$114.46
|
| Rate for Payer: United Healthcare All Payer |
$104.92
|
|
|
MARCAINE SPINAL (BUPIVACAI 2ML
|
Facility
|
IP
|
$78.59
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Aetna Commercial |
$60.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$65.23
|
| Rate for Payer: First Health Commercial |
$74.66
|
| Rate for Payer: Humana Commercial |
$66.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.16
|
| Rate for Payer: Ohio Health Group HMO |
$58.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.23
|
| Rate for Payer: PHCS Commercial |
$75.45
|
| Rate for Payer: United Healthcare All Payer |
$69.16
|
|
|
MARCAINE SPINAL (BUPIVACAI 2ML
|
Facility
|
OP
|
$78.59
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$75.45 |
| Rate for Payer: Aetna Commercial |
$60.51
|
| Rate for Payer: Anthem Medicaid |
$27.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$65.23
|
| Rate for Payer: First Health Commercial |
$74.66
|
| Rate for Payer: Humana Commercial |
$66.80
|
| Rate for Payer: Humana KY Medicaid |
$27.03
|
| Rate for Payer: Kentucky WC Medicaid |
$27.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.16
|
| Rate for Payer: Ohio Health Group HMO |
$58.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.23
|
| Rate for Payer: PHCS Commercial |
$75.45
|
| Rate for Payer: United Healthcare All Payer |
$69.16
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
OP
|
$116.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003202
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem Medicaid |
$40.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Humana KY Medicaid |
$40.15
|
| Rate for Payer: Kentucky WC Medicaid |
$40.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.55
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
IP
|
$116.74
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003202
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.55
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
OP
|
$116.74
|
|
| Hospital Charge Code |
636T0090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem Medicaid |
$40.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Humana KY Medicaid |
$40.15
|
| Rate for Payer: Kentucky WC Medicaid |
$40.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.55
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
|
MARCAINE W/EPINEPH 0.25% 30ML
|
Facility
|
IP
|
$116.74
|
|
| Hospital Charge Code |
636T0090
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$112.07 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.06
|
| Rate for Payer: Cash Price |
$58.37
|
| Rate for Payer: Cigna Commercial |
$96.89
|
| Rate for Payer: First Health Commercial |
$110.90
|
| Rate for Payer: Humana Commercial |
$99.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.73
|
| Rate for Payer: Ohio Health Group HMO |
$87.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.55
|
| Rate for Payer: PHCS Commercial |
$112.07
|
| Rate for Payer: United Healthcare All Payer |
$102.73
|
|
